MaineCare Management Information System MMIS

1
MaineCare Management Information System (MMIS)
Fiscal Agent Solution

• Health PAS The Right Choice
• Introduction of Unisys
• February 21, 2008

2
Solution Overview

• Tim Skeen

3
High Level OverviewHealth PAS solution.

• Fully operationalized CMS certified for the
  Medicaid market
• Integrated, rules-based COTS software solution
  built on an open systems architecture foundation
• DRA and MITA aligned solution that is the result
  of ten years of investment revolutionizing the
  Medicaid environment into a modern, n-tiered
  distributed computing environment
• Complete suite of solutions that cover the entire
  technology enterprise needed by healthcare payers

4
Health PAS is Industry Leading

• Only COTS-based CMS certified solution
• Proven, operationalized, battle-tested in
  Medicaid
• COTS modernization and evolution supports a
  continuous innovation platform that provides
  power for reform, innovation, sustainability
• Utilizes rich commercial applications rather than
  custom code written utilizing COTS toolkits
• Loosely coupled to support evolution
• MITA DRA aligned
• Moves Maine closer to CMS vision of MMIS
• Already supporting the implementation of West
  Virginias approved DRA plan

5
Health PAS is Flexible

• Multi-plan multi-payer capabilities
• Maine can leverage a single system across
  multiple programs agencies
• Configurable rules-based design
• Supports current future reform initiatives
• Department users can see their benefit rules
  configured in the system using dynamic parameters
  in real time
• Changes to rules are done in English, not cryptic
  code
• Enables change requests to be processed quickly
• Positions Maine to handle both minor major
  changes in requirements faster and more cost
  effectively than any other solution in the
  industry
• Most changes implemented by business analysts,
  without programming
• Policy drives the technology
• Policy decision makers have the freedom to think
  outside the box

6
Health PAS is Extensible

• Plug play capabilities allow for integration
  of Maines current and future software
  applications
• Allows Maine to quickly add or replace components
• MITA aligned
• Fully integrated extensible supporting a
  strong foundation for future expansion
• Allows the MMIS to become the hub of the
  universe
• Access from other approved entities

7
Health PASFunctional overview.

• Administrator
• Claims Processing Engine
• Financial Management
• Process Manager
• Automated Workflow Management
• Document Manager
• Document Imaging
• Optical Character Recognition (OCR)
• Letter Report Generation
• Storage Management
• Analytics
• Decision Support
• Data Warehouse
• Fraud Abuse Detection
• MARS SURS

• InterComm
• Internal Project Management Operations Portal
• OnLine
• Provider Portal
• Member Portal
• Contact Manager
• Call Center
• Correspondence
• Eligibility Verification
• Rx
• Pharmacy Point of Sale
• Drug Utilization Review
• Pharmacy Rebate

8
Health PAS-AdministratorClient benefits.

• Reduce administrative operating costs
• Introduce and support new benefit plans payment
  models
• Manage control benefit expenditures
• Increase preventative care efficiency through
  comprehensive case management

9
Health PAS-AdministratorGraphical user interface
(GUI).

• Web browser interface
• On-demand online help
• Security-based information access

10
Health PAS-Process Document ManagersSophisticat
ed workflow document management.

• Intelligent workflow engine
• Automates manual tasks
• Secure handling of documents

• End-to-end tracking / accountability
• Process integrity
• Customer responsiveness

11
Analytics - Medstat Advantage Suite DW/DSS

• The leading Medicaid DW/DSS solution
• Analytically-ready data warehouse, customized for
  Maine
• High standards for data quality, reliability,
  credibility
• Full-time, on-site analytic support from Thomson
  Healthcare
• Integrated DSS tools with built in healthcare
  intelligence
• MARS with advanced financial reporting
• Performance measurement unique Measures Catalog
• Benchmarks for New England, Maine, Medicaid,
  Best Practice
• Clinical practice protocols outcome measures
• Episodes and risk adjustment
• Executive Information System
• Patient Health Record

12
Patient Health Record An integrated view
Tab to all clinical details
Patient demographics
Cost summary, drugs, ER experience
Projected Future Cost
Instant view of utilization history
13
Health PAS-OnLineAdvanced Internet portal.

• Secure Direct Data Entry (DDE)
• Patient and provider rosters
• Wizard-like interface
• Robust data edits
• Online help

• Many Transaction Types
• Eligibility verification
• Service authorization
• Claims
• Claim status
• Long term care billing

14
Health PAS-OnLineAdvanced Internet portal.

• Secure Batch
• Submission Distribution
• Automatic X12 compliance check
• Speedy transmission through data compression

• Readable X12 transactions through
  automatically-generated PDF reports

15
Health PAS-OnLineAdvanced Internet portal.

• Quick Information Delivery
• Announcements
• Inbound message routing

• Publication posting
• Provider directories
• Training descriptions schedules

16
Health PAS-Contact ManagerSuperior customer
service.

• Efficient incoming call management
• Intelligent call routing
• Timesaving pre-populated windows (known as
  window pops)
• Comprehensive call recording capabilities
• Robust automated voice solutions
• Real-time reporting